Case :skin and soft tissue infections

Question 1

SSTI = skin & soft tissue infections

Answer 1

-impetigo
-eccthyma
purulent
-nec fasc

Question 2

SSTI workup

Answer 2

hx==friction on skin
- immune status, travel, trauma/surgery; prior abx x, hobbies/sports, exposures/bites hosehold exposure

exam
radiologic exam
surgical debridement / IandD

Question 3

SSTI manageent

Answer 3

nonpurulent (cellulitis) ==> ORAL (5d)
[LOCATION, RATE OF SPREAD]

purulent (abscess) ==> systemic
[LOCATION, SYSTEMIC SXS]

Question 4

IMPETIGO

Answer 4

bullous = staph aureus
nonbullous = staph aureus, strep pyogenes
tx = abx x5d

Question 5

ecthyma

Answer 5

deep==> involving dermis
+ scaly adherent crust

esp at sites of insect bites, in tropical zones

== staph, strep

Question 6

treatment for impetigo, ecthyma

Answer 6

ORAL = numerous lesions, outbreaks affecting many pple (esp. in same household); outbreak of post-strep GN

impetigo (5d), ecthyma (7d)

Question 7

abscess

• bugs
• treatment

Answer 7

polymicrobial
MSSA, MRSA

tx = (1) I and D; keep diving; (2) warm packs, soaks to thin the skin overlying so it will rupture

don’t need Abx if adequate I,D. If needed –> keflex (b/c doesn’t do anything better than Clinda – C. diff and nasty taste)

Question 8

indications for SSTI abx

Answer 8

• multiple locations
• rapid progression of associated cellulitis
• systemic signs of illness (fever, tachypnea, tachy, WBC >1200, <400)
• extremes of age
• associated septic phlebitis
• no response to I&D alone with saline
• ? recurrent abscess

==> lower severity in those with fever, children <1yo (regardless of clinda v. keflex)

Question 9

treatment for recurrent abscess

Answer 9

• antibiotics
  +/- household decolonization (daily use of chlorhexadine, mupirocin BID to nares, clean all cloth in house) ==> helpful in short run to reduce SSTI recurrence

Question 10

erysipelas

Answer 10

“orange peel” skin ==> look due due to follicles

Question 11

are blood cultures to be used in kids with SSTI?

Answer 11

ONLY in necrotizing fasciitis

otherwise, not helpful b/c if abscess - would do abscess culture

Question 12

necrotizing fasciitis

Answer 12

pain out of proportion to the exam –> esp. in areas that don’t look infected, damaged

tx = empiric broad spectrum Abx + immediate surgical consult (prior to CT, any imaging)

Question 13

is there a group who are at higher risk of bacteremia

Answer 13

kids < 1yo

–> higher risk of treatmentfailure, need for incision and drainage

Question 14

first-line treatment for SSTI

Answer 14

inpatient == clindamycin
outpatient === Keflex

treatment failure ==> vancomycin, linezolid

Question 15

what type of imaging would you use for evaluating an abscess

Answer 15

US